Is there a link between TN and Glossodynia, or "Burning Mouth Syndrome"?

Hello all,

I have read that disorders of the cranial nerves can cause this disorder I just read about known as Glossodynia, or "Burning Mouth Syndrome".

After reading the symptoms of Glossodynia, I have ALL of these symptoms. I am wondering if anyone else does, and if anyone can validate for me if there is a link between these two conditions. Perhaps, Glossodynia is a side effect of Trigeminal Neuralgia. My mouth BURNS! My face aches, throbs, and feels like is being crushed and seared. Sometimes, I can feel my teeth throbbing all at once as my cheeks sear with pain. However, a big part of the problem seems to be the burning in my tongue, gums, and most tissues inside the mouth.

It says that is gets worse as the day progresses. I have a pain spike in the afternoon. I think this is another problem I have, which I can add to the cervical spine Scoliosis and the Atypical Trigeminal Neuralgia.

Does anyone know anything else about this disorder, Glossodynia, or if it is just another symptom of TN?

Sending good vibes for compassionate care and prayers for a strong will to fight this condition to all who suffer.

Stef

P.S. By the way, I will be beginning my anti-inflammation diet today. I will let you all know if my diet approach is helping. I know a lot of you out there are trying different kinds of types.

it could still be TN. the tissues in the mouth are still served by the trigeminal nerve. glossodynia is a burning pain, but it is usually temporarily relieved (according to research) by chewing gum, drinking cold liquids or, most frequently, by the gold standard treatment, klonopin. the outer lips frequently burn in glossodynia as well. bilateral pain is more common.

glossodynia is a small fiber neuropathy; it is not connected to TN or a side effect of it. if you have TN, the pain in your mouth may simply be a progression of the disease. see a neurologist who will know more. one who has a special interest in small fiber neuropathy would be best.

good luck,

vesper

Thank you for your advice, Vesper. I will endeavor to do so. I am set up to see a Facial Pain Specialist. My current Neuro seems to have little knowledge of Trigeminal or Atypical Trigeminal Neuralgia. I am going to get a second opinion fro another Neuro, and see the Facial Pain Specialist.

When I read this today, I just thought, wow, I fit that description too, so I had to ask! Much appreciation for the info.

vesper venustas said:

it could still be TN. the tissues in the mouth are still served by the trigeminal nerve. glossodynia is a burning pain, but it is usually temporarily relieved (according to research) by chewing gum, drinking cold liquids or, most frequently, by the gold standard treatment, klonopin. the outer lips frequently burn in glossodynia as well. bilateral pain is more common.

glossodynia is a small fiber neuropathy; it is not connected to TN or a side effect of it. if you have TN, the pain in your mouth may simply be a progression of the disease. see a neurologist who will know more. one who has a special interest in small fiber neuropathy would be best.

good luck,

vesper

. . .and I’ve tried Klonopin. It does nothing for my pain, except for knocking me out! So, I suppose the “gold standard” for that disorder does nothing for mine.

good luck with your specialist appointment. i have a few posts here on the forum; you can do a search (possibly under my name) for them; you may or may not find them useful.

vesper

Hey Stef,

You may be interested in looking at Glossopharyngeal Neuralgia (here is one site describing it): http://facial-neuralgia.org/conditions/tn-gn.html and there is a support site you could talk to folks there about your symptoms, a sister site to LWTN if you will - it's at http://www.livingwithgpn.org/

Glossopharyngeal neuralgia is characterized by excruciating shock-like-pain in the region of the tonsilar fossa, pharynx, or base of the tongue. It can radiate to the ear or the angle of the jaw or into the upper lateral neck. The trigger zone is often in the same area, and patients frequently report that swallowing, yawning, clearing the throat, or talking is the precipitating stimulus. The pain often appears to be spontaneous. Chewing or touching the face does not precipitate an attack. Glossopharyngeal neuralgia is much less common than tic douloureux---the incidence ratio is about 1:100.

Tic douloureux as it mentions there as you likely know - is Trigeminal Neuralgia. It is possible for a person to have more than one cranial neuralgia at a time, and three is a magic number for me ...

Cheers,

Kerry.

I know this is a long time coming, but I have lupus and I have both TN and reoccuring burning mouth syndrome. I also get smell distortions, kind of like a metallic or copper smell. It's very annoying. I am convinced there is a correlation between the two and that it is all part of cranial nerve disorders. Too much cooincidence for me to not think so. Please contact me, ■■■■■■■■■■■■■■■■■■■.

I had shingles in my throat pharynx face neck affected cranial nerves and trigeminal nerve. A year later one with TN pain I get severe throat pain and nausea . All starts with smiling talking a lot eating something scratchy or spicey.

Stef,

I could have written this myself. Everything you are experiencing I am too! TN pain gets really bad in late afternoon and continues until bedtime. I have bilateral TN and the burning you described. Teeth pain, cheeks hurt, under the edge of my jaw sends shooting pain. I have pain in back sides of my tongue. Stef, have you lost any feeling in your throat? I can swollow, BUT once it passes the back of my tongue (pass my tonsils) I can't feel anything, no food going down. I also have 6 herniated disc in my cervical spine with arthritic changes and bone spurs. Once the mouth burning starts I start drinking cold drinks .all day long. I go thru 12 16.9 oz.bottles . of diet rassberry green tea a day. So much for the 8 glasses a day I do 12 to 16. It doesn't stop the soft paletta (roof of mouth) from burning, it just cools it off so I can tolerate it. When I speak to my neurologist, internist and neurosurgeon; they look at me like I''m crazy. Thank you sharing Stef. Your are not alone.

Here is an extract from an on-line medical information subscription service, "Up To Date". It's authoritative, but I'm uncertain if it's helpful...

Author Ivan Garza, MD
Section Editor Jerry W Swanson, MD
Deputy Editor John F Dashe, MD, PhD
All topics are updated as new evidence becomes available and our peer review process is complete.
Literature review current through: Dec 2012. | This topic last updated: Mar 28, 2012.

Burning mouth syndrome — Burning mouth syndrome is characterized by an intraoral burning sensation for which no medical or dental cause can be found [2]. Prior to making the diagnosis, it is important to rule out oral mucosal diseases, such as herpes simplex and aphthous stomatitis.

Other common conditions associated with mouth pain are psychiatric disorders, xerostomia (from drugs, connective tissue disease, or age), nutritional deficiencies (vitamin B12, iron, folate, zinc, vitamin B6), and allergic contact stomatitis. More unusual causes of mouth pain include geographic tongue, candidiasis, diabetes, denture-related pain, thyroid abnormalities, and menopause [33,34].

One study suggests that trigeminal small-fiber sensory neuropathy is the cause of so-called idiopathic burning mouth syndrome [35]. Other studies identified a significantly higher number of unoccupied D2 dopamine receptors in the putamen associated with painful clinical conditions [36]. In this regard, a report described a patient with burning mouth syndrome whose pain responded to pramipexole, a nonergot dopamine agonist with a high selectivity for dopaminergic D2 receptors [37].

Treating the underlying cause of mouth pain, if found, usually results in the remission of the symptoms [30]. When no underlying cause of symptoms is found, the condition is called "burning mouth syndrome".

The diagnostic criteria include [2]:

Pain in the mouth present daily and persisting for most of the day
Oral mucosa is of normal appearance
Local and systemic diseases have been excluded

Pain may be restricted to the tongue and may be associated with paresthesias, altered taste, and/or a sensation of having a dry mouth [2]. This condition predominantly affects women, and 30 to 50 percent of patients improve spontaneously [30].

The bracketed numbers are references to Pub Med at the US National Library of Medicine. Reference 2, for instance is

Cephalalgia. 2004;24 Suppl 1:9-160. The International Classification of Headache Disorders, 2nd Edition.
Headache Classification Subcommittee of the International Headache Society.

Here's what I found on BMS. I sight each source at the fore of each excerpt.

http://www.webmd.com/pain-management/video/burning-mouth-syndrome

glitch in CNS, nerves that control taste and smell

Causes

By Mayo Clinic staff

The cause of burning mouth syndrome can be classified as either primary or secondary.

Primary burning mouth syndrome
When the cause of burning mouth syndrome isn't known, the condition is called primary or idiopathic burning mouth syndrome. Some research suggests that primary burning mouth syndrome is related to problems with taste and sensory nerves of the peripheral or central nervous system.

Evidence of chorda tympani dysfunction in patients with burning mouth syndrome

  1. Eli Eliav, DMD, PhD,
  2. Batya Kamran, DMD,
  3. Rachel Schaham, DMD,
  4. Rakefet Czerninski, DMD,
  5. Richard H. Gracely, PhD and
  6. Rafael Benoliel, BDS

Abstract

Background. More than two-thirds of patients with burning mouth syndrome (BMS) have altered taste sensation. The authors conducted a study to assess chorda tympani and trigeminal nerve function in these patients.

Methods. The study was composed of 48 patients; 22 were diagnosed as having BMS, 14 had burning symptoms related to other diseases and were diagnosed as having secondary burning mouth syndrome (SBMS), and 12 were healthy volunteers. The authors evaluated the electrical detection thresholds of the infraorbital and mental nerves and the electrical taste and electrical detection/tingling thresholds in the anterior two-thirds of the tongue for all patients. Electrical taste threshold is thought to be dictated by chorda tympani nerve function while electrical detection/tingling thresholds are regulated by trigeminal nerve function.

Results. The mean electrical taste/tingling detection thresholds ratio and the taste detection thresholds were significantly higher in patients with BMS than in patients with SBMS and in control subjects, indicating chorda tympani nerve dysfunction. Eighteen (82 percent) of the 22 patients with BMS demonstrated chorda tympani dysfunction (13 unilateral and five bilateral).

Conclusions. Chorda tympani hypofunction may play an important role in BMS pathology. Unilateral hypofunction may be sufficient to produce generalized burning sensation exceeding the affected nerve area.

Clinical Implications. Elevated taste detection threshold levels determined via electrogustatory testing and an elevated taste/tingling detection thresholds ratio may assist clinicians in the diagnosis of BMS. More studies are needed to validate these findings.

Neurogenic Mechanisms in Burning Mouth Syndrome (BMS17)

This study has been completed.

First Received on April 2, 2009. Last Updated on February 22, 2011 History of Changes

Sponsor:

University of Copenhagen

Information provided by:

University of Copenhagen

ClinicalTrials.gov Identifier:

NCT00875537

Purpose

Burning mouth syndrome (BMS) is characterized by a bilateral burning sensation in the anterior tongue, hard palate and lips in the absence of any clinical or laboratory findings. The term syndrome implicates the simultaneous presence of oral dryness (xerostomia) and altered taste (dysgeusia) in addition to the burning sensation in the oral mucosa. BMS is most often seen in women and is more frequent during menopause. The etiology and pathogenesis are still unclear but recent studies suggest that BMS is a neuropathic pain condition.

The objectives of the study are:

  • To clarify potential neurogenic mechanisms behind BMS using immunohistochemistry (IH) to characterize the localization and distribution of peripheral nerve fibres, neuropeptides like substance P, calcitonin gene-related peptide, nerve growth factor, nerve growth factor receptor, PGP 9.5 neuronal marker and TRPV1 as well as inflammatory/structural changes.
  • To perform a randomized double blind cross-over intervention study to examine the efficacy and safety of topical application of capsaicin oral gel (on the tongue) to relieve the burning sensation in patients with BMS.

Condition

Intervention

Phase

Burning Mouth Syndrome

Other: Capsaicin oral gel 0.025%
Other: Capsaicin oral gel 0.01%

Phase 0

Study Type:

Interventional

Study Design:

Allocation: Randomized
Endpoint Classification: Safety/Efficacy Study
Intervention Model: Crossover Assignment
Masking: Double Blind (Subject, Investigator, Outcomes Assessor)
Primary Purpose: Treatment

Official Title:

Neurogenic Mechanisms in Burning Mouth Syndrome With Focus on Localization and Desensibilization of Vanilloid Receptor TRPV1

Resource links provided by NLM:

MedlinePlus related topics: Burns

Drug Information available for: Capsaicin

U.S. FDA Resources

Further study details as provided by University of Copenhagen:

Primary Outcome Measures:

  • Primary outcome: To evaluate the efficacy and safety of topical application of capsaicin oral gel (using to different concentrations) to relieve the burning sensation in patients with BMS and alleviate BMS related symptoms. [ Time Frame: 6 months ] [ Designated as safety issue: Yes ]

Secondary Outcome Measures:

  • To characterize the localization and distribution of peripheral nerve fibres, neuropeptides like substance P, calcitonin gene-related peptide, NGF, NGF-R, PGP 9.5 neuronal marker and TRPV1 as well as inflammatory/structural changes. [ Time Frame: 6 months ] [ Designated as safety issue: No ]

Estimated Enrollment:

26

Study Start Date:

January 2009

Study Completion Date:

June 2010

Primary Completion Date:

April 2010 (Final data collection date for primary outcome measure)

Arms

Assigned Interventions

Active Comparator: Capsaicin oral gel 0.01%

Other: Capsaicin oral gel 0.01%

Application 3 times daily for 14 days on the tongue, followed by 14 days wash-out

Other Name: Capsicum, extract from chilipepper

Active Comparator: Capsaicin oral gel 0.025%

Other: Capsaicin oral gel 0.025%

Application 3 times daily for 14 days on the tongue, followed by 14 days wash-out

Other Name: Capsicum, extract from chilipepper


Detailed Description:

Data which support the hypothesis that BMS is a neuropathic pain condition include amongst others a recent clinically controlled study that has shown up-regulation of TRPV1-positive nerve fibres in tongue mucosa in patients with BMS. The vanilloid receptor-1 (TRPV1) is a voltage-dependent cation channel expressed by the unmyelinated C-nociceptive nerve fibres and the receptor may be activated by capsaicin (from chili peppers), heat and H+. Capsaicin binds to the TRPV1 receptor causing depolarization of the C-nociceptors. Prolonged activation of these neurons by capsaicin depletes pre-synaptic substance P and makes them unable to report pain.

Eligibility

Ages Eligible for Study:

18 Years to 70 Years

Genders Eligible for Study:

Female

Accepts Healthy Volunteers:

Yes

Criteria

Inclusion Criteria:

  • non-smoking female patients with burning mouth syndrome (n=26)
  • healthy aged-matched control group (n=10)

Exclusion Criteria:

  • pregnancy and lactation (inclusion requires negative pregnancy test)
  • women who do not use safe anticonception
  • patients with know allergy/hypersensitivity to capsicum and other capsaicinoid-containing products
  • Active infection which requires antibiotic treatment
  • use of mouthrinse. The use of these is stopped 14 days before inclusion
  • patients who are able to give informed consent due to physical or mental disabilities

Contacts and Locations

Please refer to this study by its ClinicalTrials.gov identifier: NCT00875537

Locations

Denmark

Department of Odontology, Section of Oral Medicine, Clinical Oral Physiology, Oral Pathology & Anatomy

Copenhagen, Denmark, 2200

Sponsors and Collaborators

University of Copenhagen

More Information


No publications provided

Responsible Party:

Anne Marie Lynge Pedersen/associate professor, PhD, DDS, Department of Odontology, Faculty of Health Sciences, University of Copenhagen

ClinicalTrials.gov Identifier:

NCT00875537 History of Changes

Other Study ID Numbers:

H-A-2008-118

Study First Received:

April 2, 2009

Last Updated:

February 22, 2011

Health Authority:

Denmark: Danish Medicines Agency
Denmark: Ethics Committee
Denmark: Danish Dataprotection Agency
Denmark: The Regional Committee on Biomedical Research Ethics


Keywords provided by University of Copenhagen:

Burning mouth syndrome
neuropathy
inflammation

tongue mucosa
tongue innervation
dysgeusia


Additional relevant MeSH terms:

Burning Mouth Syndrome
Burns
Mouth Diseases
Stomatognathic Diseases
Wounds and Injuries
Capsaicin
Sensory System Agents

Peripheral Nervous System Agents
Physiological Effects of Drugs
Pharmacologic Actions
Antipruritics
Dermatologic Agents
Therapeutic Uses

It is old info that BMS is psychological in nature and Mayo Clinic has changed their info to show that.

HUGS, Julie

The unchallenged association of BMS with psychological factors is one of the reasons why I pointed out that the article by Garza while authoritative in its references was not particularly helpful.

Regards, Red